NASAL ALLERGY NASAL ALLERGY

NASAL ALLERGYNASAL ALLERGY

Allergic rhinitis is an IgE-mediated type 1 hypersensitivity reaction in the mucous membranes of the nasal airways.

The disease is very common, affecting approximately 30% of the population.

It can be seasonal or perennial .

allergen allergen

Inhalants : They may be seasonal(Pollens from grasses, flowers and trees ) or perennial (house dust ; Epithelial debris from domestic cats and dogs )

Food and drugs: include various types of foods, but especially wheat and dairy products and drugs, such as aspirin, iodine and antibiotics,

Symptoms Symptoms

nasal itching violent

sneezing profuse

watery nasal discharge

itching and watering of the eyes

nasal stuffiness

AppearancesAppearances

In the acute stage: pale edematous mucosa with excessive thin watery mucoid secretion is typical.

In the chronic stage: the mucosa is swollen, but its colour is deeper red or even slightly blue, depending on the degree of venous congestion.

Diagnosis Diagnosis a precise history ; oedema and vasodilatation of the m

ucosa. eosinophils in the nasal secretionskin testing blood tests : allergen-specific IgE in

the serum.

TreatmentTreatment

1. A voidance of the allergen

2. use of drugs

3. Specific hyposensitization

4. Surgical treatment

A voidance of the allergenA voidance of the allergen

The use of drugsThe use of drugs 1.antihistamines are the best treatment for

symptomatic relief, but the classic antihistamines are often soporific .

2. Steroids :injection;or oral medication; the local inhalers and sprays

3.sympathomimetic and vasoconstrictor drugs (in the form of drops and sprays)

4. mast cell stabilizer(in the form of inhalers and sprays): Sodium cromoglycate (Rynacrom), for example, prevents the type I hypersensitivity reaction being initiated by the arrival of the antigen in the nasal mucosa

Specific hyposensitizationSpecific hyposensitization

Through skin testing, we can identify the exact of the allergen. Weekly injections of increasing dosage of the allergen are given for several months before the expected exposure; this implies starting early in the year in the case of hay pollinosis. Yearly boosting injections are also needed. But its safety in still in question.

Surgical treatment Surgical treatment

It has little part to play in the management of nasal allergy,

NASAL POLYPSNASAL POLYPS

NASAL POLYPSNASAL POLYPS

Nasal polyps are greyish masses of pedunculated tissue resembling a bunch of grapes. They are generally multiple, nearly always bilateral and produce nasal blockage by their presence. It has a very high recurrence rate.

AetiologyAetiology

The cause is essentially unknown. Vasomotor imbalance, saccharide abnormalities , allergy , infections, aspirin hypersensitivity and the change of micro-environment in the middle meatus may all have a role. The cause of nasal polyps is a result of many factors action.

Histopathology.Histopathology.

Histologically polyps have a ciliated columnar epithelium, a loose vascular grossly edematous stroma, and are infiltrated with plasma cells and many eosinophils. The epithelium may become squamous if the polyp presents at the nostril.

Clinical featuresClinical features Symtom:nasal obstruction usually

bilateral; mucoid or purulent discharge, pus indicates associated sinus suppuration; olfactory dysfunction; headache;

Clinical featuresClinical features

physical examination : polyps looks soft, bleeds uneasily and are painless. In less advanced cases, smaller polyps may closely resemble blobs of mucus but are not cleared by blowing the nose. In advanced cases , the multiple grey polypoidal masses may totally fill the nose bilaterally, the external nose may become broadened ,the condition is known as “frog face”.

Treatment Treatment medical treatment: prednisolone, follo

wed by the use of aqueous bec1omethasone, or a similar preparation.

surgical treatment: avulse the polyps ;control the predisposing factors such as sinusitis, deviation of nasal septum.

After surgical treatment, decongestant drops and the use of steroid(in the form of drops and sprays) are very helpful and should be provided long term.

Sinusitis Sinusitis

Anatomy of PNSAnatomy of PNS

Nasal sinuses are a group of air containing spaces that surround the nasal cavity.

frontal sinus

ethmoid sinus

maxillary sinus

sphenoid sinus

Characteristic of maxillary Characteristic of maxillary sinussinus

Early in development Large capacity (13m

l-30ml) Low floor and high o

stia Ostia is situated in po

stero-lateral wall:lowest

Maxillary sinusMaxillary sinus Anterior wall: zygomatic proce

ss of maxillary, canine fossa, infraorbital foramen

Posterior wall: pterygopalatine and infratemporal fossa

Medial or nasal wall: maxilla, perpendicular plate of palatine bone, uncinate process of ethmoid bone, lacrimal bone.

maxillary sinus ostia Roof: floor of orbit Floor(alveolar process): below

the nasal floor

Ethmoidal sinusEthmoidal sinus

The number:8-18Ethmoidal labyrinthAnterior ethmoidal sinus (sm

aller,much) opens in middle meatus Posterior ethmoidal sinus (la

rger,few) opens in superior meatus

Ethmoidal sinusEthmoidal sinusRoof:cribriform plate, orbital plate of frontal bon

eFloor:orbital plate of maxilla, palatines bonesLateral or orbital wall: lamina papyracea, lacrima

l boneMedial or nasal wall: middle and superior turbina

te bonesPosterior wall: related to sphenoid sinus

Frontal sinusFrontal sinus

Unequal size A bony septum between two frontal sinuses.Opens into anterior part of middle meatus th

rough frontonasal duct.

Frontal sinus Frontal sinus

Anterior wall: diploeic bonePosterior wall:thin base separa

tes it from anterior cranial fossa

Medial wall:septum between the two sinuses

Floor:superior orbital wall separating it from orbit

Sphenoid sinus

Sphenoid sinusSphenoid sinus

Contained in the body of sphnoid bone and are situated in the posterior part of nasal cavity.

Rudimentary at birth but begin to grow after 3 year.

Capacity varies from 0.5ml to 30ml with an average of 7.5ml

Ostium opens into sphenoethmoidal rescess.

Sphenoid sinusSphenoid sinusRoof: pituitary gland, optic chiasma,fron

tal lobe and olfactory tract.Floor: roof of nasopharynx and vidian ne

rve.Posterior wall:thick wall separates it fro

m brainstem and basilar artery.Lateral: cavernous sinus, internal caroti

d artery , optic nerve.

Drainage of sinusesDrainage of sinuses Anterior sinuses：

– Frontal sinus, middle meatus

– Anterior ethmoidal sinus, middle meatus

– Maxillary sinuses, middle meatus

Posterior sinuses：– posterior ethmoidal sinus,

superior meatus– Sphenoidal sinus, sphenoet

hmoidal recess

SinusitisSinusitisSinusitis is the inflammatory condition

mucous membrane lining of the sinuses .The maxillary sinus clinically the most

commonly affected, followed by the ethmoid, frontal and sphenoid sinuses in that order.

Maxillary sinusitis may occur alone or with involvement of the other sinuses. Infection in the other groups of sinuses rarely occurs without maxillary sinusitis, and indeed the key to their treatment is generally the control of the maxillary sinusitis itself.

the middle meatus play a pivotal role in most diseases of the sinuses, and that most inflammations of the maxillary, frontal and ethmoid sinuses arise from this point

Aetiology and predisposing factors Pathology Acute sinusitis Clinical features

Diagnosis

Treatment: Chronic sinusitis Clinical features

Diagnosis

Treatment: Complications

Aetiology of sinusitis Aetiology of sinusitis

1. Acute infective rhinitis (common cold or influenza) and other nasal diseases.

2. Dental extraction or infection. 3. Swimming and diving.4. Fractures involving the sinuses.

Chronic inflammation of the sinuses usually follows recurrent acute sinusitis

Predisposing factors Predisposing factors 1.Local Pre-existing rhinitis Nasal polyps. Nasal foreign body. Upper respiratory tract infection Nasal anatomical variations. Nasal tumour. 2.General Debilitation. Immunocompromised host. Mucociliary disorders (e.g. Kartagener's syndrom

e).

pathogenic bacterium ： streptococci; pneumococci(29%); staphylococci (6.6%) ;haemophilus influenzae (48%) ; ， aspergillus

Pathology Pathology

The mucous membrane passes through all the usual stages of infection ： outpuring of secretion , purulent, ineffective ciliary action , destructive cilia, membrane thicken, granulation , fibrous tissue formation

ACUTE SINUSITISACUTE SINUSITIS

Clinical features Diagnosis Treatment:

Clinical featuresClinical features1.general symptom: fever; fatigue;

loss of appetite2.local symptom:

nasal obsruction

much purulent discharge

headache (its position, time） loss of sense of smell

Maxillary sinus pain :an aching over the antrum, often with aching in the upper teeth. There may be tenderness on pressing in the region of the canine fossa.

Frontal sinus pain :is known as a 'vacuum frontal headache'. A distinctive symptom of frontal sinus infection is pain above the eye.coming on at morning ,releasing at afternoon. Tapping over the frontal region may be painful.

Ethmoidal headache is usually deep-seated and felt behind the eyes, with tenderness around the region of the inner canthus.

sphenoidal headache is usually described as being felt deeply in the centre of the head.

DiagnosisDiagnosis

1.history and symtom:

2.physical examination: reddened and oedematous, especially those of middle turbinate, middle meatus and uncinate process. A trickle of pus will be seen coming from middle meatus or olfactory sulcus.

3.X-ray examination and CT scanning

4.Diagnostic wash-out (proof puncture). Investigation of the maxillary air sinus can be carried out by puncture through the inferior meatus.Wash-out is a diagnostic procedure to demonstrate the contents of the maxillary sinus.

Treatment: Treatment:

principles: eradicating the pathogenesis; restoring the patency of the ostia of the sinuses, so promoting drainage; controlling the infection and preventing complication.

1. medical treatment: nasal decongestive drops or sprays (Ephedrine 0.5-1.0% in normal saline) and steroid inhalers and sprays are used to promote sinus drainage; antibiotic according to bacteriology report

2.  Physiotherapy ： fomentation; infrared radiation 3. method of maxillary sinus wash-out 4.surgical treatment is occasionally needed in the tre

atment of acute sinusitis. It is reserved for those patients in whom improvement is not occurring and in whom pain or headache continues to be severe.

CHRONIC SINUSITIS CHRONIC SINUSITIS

Clinical features

Diagnosis

Treatment:

Clinical featuresClinical features

1.general symptom: slighter than acute sinusitis 2.local symptom: Chronic infection of the sinus is cha

racterized in most cases by the formation of polyps

nasal obsruction

much purulent discharge.

headache: slighter than acute sinusitis.

hyposmia because of nasal obstuction

obstruction of vision :

Diagnosis:Diagnosis:

1.history and symtom: 2.physical examination: reddened, oedematou

s and hypertrophy especially those of middle turbinate, middle meatus and uncinate process; A trickle of pus coming from middle meatus or olfactory sulcus; the formation of polyps.

3. X-ray examination and CT scanning are the best means of imaging the sinuses

4. Diagnostic wash-out (proof puncture).

TreatmentTreatmentmedical treatment: nasal decongestive drops o

r sprays (Ephedrine 0.5-1.0% in normal saline) and steroid inhalers and sprays are used to promote sinus drainage; antibiotic according to bacteriology report

method of maxillary sinus wash-outoperation on the nasal cavity and sinus. Endo

scopic sinus surgery is operated broadly.

Complication Complication

orbital complications: intracranial complications:

Orbital Complications:Orbital Complications:1) Inflammatory edema: 2) Orbital cellulitis: 3) Subperiosteal abscess: 4) Orbital abscess:

intracranial Complicationsintracranial Complications

Brain Abscess Meningitis:Subdural/Epidural AbscessesCavernous Sinus Thrombosis   

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